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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Platelet Dysfunction in Pediatric Patients on the Ketogenic Diet Kristin N.Maher1, Susanna Fenstermacher2, Nabiha H.Saifee3, Jason P.Lockrow4. 1Department of Pediatrics, Division of Hematology, Oncology, Bone Marrow Transplant and Cellular Therapy, University of Washington, Seattle, WA, USA.2Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, WA, USA.3Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.4Department of Neurology, University of Washington, Seattle, WA, USA |
Abstract
Background: The ketogenic diet is a treatment for patients with drug-resistant epilepsy and carries with it broad impacts to metabolism and associated risk for systemic complications. A previous study reported increased bruising and bleeding in 30% of a cohort of children on the ketogenic diet, and many of those had evidence of significantly impaired platelet aggregation, with decreased response to multiple agonists. This was hypothesized to be related to changes in platelet membrane composition and function. Potential bleeding risk related to platelet dysfunction is consequential in this population because of the frequent need for surgical interventions. Following a case of post-operative hematoma in a pediatric patient on the ketogenic diet, our institution began systematically screening for platelet dysfunction prior to all high-risk surgeries. Objectives: This study aimed to: (1) describe the prevalence and types of platelet aggregation abnormalities seen in pediatric patients on the ketogenic diet and (2) evaluate the impact of platelet aggregation screening on perioperative management. Methods: Laboratory and clinical data were collected retrospectively from electronic medical records for all pediatric patients on the ketogenic diet who underwent pre-operative platelet aggregation screening at Seattle Children’s Hospital between October 2022 and November 2024. Data collected included: platelet counts, whole blood platelet aggregometry results, medication and diet history, type of surgery, and estimated intraoperative blood loss. Results: Fifteen patients (ages 3-19 years) were included. None reported clinical bleeding or bruising concerns during screening prior to surgery. All were on the ketogenic diet at the time of testing (duration of dietary therapy 9 months to 13 years, median 4.5 years), in stable ketosis (beta-hydroxybutyrate range 1.4-4.8, median 3.0 mmol/L), and on at least one anti-seizure medication (range 1-4, median 3). Mild abnormalities in platelet aggregation testing were observed in 3/15 (20%) patients: one with decreased aggregation to ADP, one to arachidonic acid, and one to both ADP and arachidonic acid. Patients with abnormal aggregation had lower platelet counts (mean 125 K/mm³) compared to those with normal aggregation (mean 276 K/mm³; P=0.001). Two patients with thrombocytopenia were receiving valproic acid; the third had pre-existing thrombocytopenia predating both the diagnosis of epilepsy and ketogenic diet therapy. No patients developed thrombocytopenia following ketogenic diet initiation. In patients with aggregation abnormalities, two received pre-operative platelet transfusion and one was managed with perioperative tranexamic acid only. No patients had excessive blood loss or other hematologic complications perioperatively. Conclusions: This study does not support a direct effect of the ketogenic diet on platelet function. While 20% of patients had mild abnormalities in whole blood platelet aggregation testing, this could be attributable to a combination of thrombocytopenia and medications. Surgical bleeding risk was mitigated in these cases with platelet transfusion and/or tranexamic acid. The absence of clinical concern for a bleeding disorder in these patients contrasts with earlier reports and may reflect improved contemporary management of the ketogenic diet for children with epilepsy.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.